Provider Demographics
NPI:1760942437
Name:BONANNO, PHILIP A (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:BONANNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:298 SAN ANTONIO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-5309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:925-281-3283
Practice Address - Street 1:298 SAN ANTONIO RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-5309
Practice Address - Country:US
Practice Address - Phone:650-446-4900
Practice Address - Fax:925-281-3283
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3076592084P0800X
WA614502972084P0800X
CA1855922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry